Due to the covid-19 pandemic, Italy has registered an incredibly high number of deaths related to the virus. The outbreak in the northern regions of the country had a higher impact than previously thought, and due to the number of lives lost each day from covid-19, a nationwide lockdown was imposed in March in an attempt to contain the spread of the disease. The country experienced its first radical change in lifestyle since World War II, with the entire population confined to their homes. During this challenging time, characterized by somatic emergencies and a lack of ventilators and intensive care beds, talking about suicide prevention may have seemed of little relevance. However, collective quarantine measures have been linked with an increase in suicidal risk, and quarantine has been associated with negative effects on mental health. [1,2]
Psychiatric services and outpatient appointments were reduced in order to limit the spread of covid-19. Individuals in crisis who needed to access these services to find a suitable treatment, and effective suicide prevention activities faced limited options.
During the 2008 economic crisis, there was a 12% increase in suicide deaths among Italian males aged 25–69 years, namely those in the labour market. [3] The covid-19 pandemic closed down most commercial activities. The ongoing economic downturn as a result of the pandemic may have a high impact on vulnerable individuals, and, as was seen during the recent economic crisis, may lead to an increase in suicides. In 2008, it was small businesses that had a higher percentage of suicides. The new crisis will produce economic precariousness along with, sadly, especially in Italy, huge grief for the vast number of deaths in some regions. We must, therefore, act proactively and help the most vulnerable groups.
The pressures of the quarantine and limited social interactions, may also lead to a worsening of household conflicts coupled with a lack of support, along with fear and isolation. This vulnerable population may therefore be at risk of worsening mental health.
The authorities are now being called on to support suicide prevention at this time of coronavirus infection in order to avoid an even more devastating effect of the pandemic. Hardships resulting from economic recessions may impact profoundly on suicide and attention should be given particularly to the following: suicide prevention awareness campaigns; specific attention to high-risk groups; proper support for those in suicidal crisis; organization of suicide prevention centres; education for health professionals on suicide prevention; focus on understanding emotional emergencies as well as the role of empathic responses; and utilization of appropriate pharmacological and nonpharmacological options for reducing suicide risk.
The coronavirus pandemic will also lead to a revolutionary approach to patients. Given the need to stay apart in order to avoid contagion, the usual face-to-face consultations for assessing patients have been replaced with digital consultations. Clinicians are requested to embrace such an approach with suicidal individuals, too, and organize valid solutions for active and sensitive responses using technological innovation. Challenging as it may be, suicide prevention strategies should be part of the intervention package for vulnerable populations. We are yet to fully understand the ongoing mental health impacts of the pandemic. We must ensure that adequate support is in place for those who need it.
Maurizio Pompili, professor and chair of Psychiatry, Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Competing interests: None declared.
References
- Barbisch D, Koenig KL, Shih FY. Is there a case for quarantine? Perspectives from SARS to Ebola. Disaster Med Public Health Prep. 2015; 9: 547-53.
- Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet. 2020;395(10227):912-20.
- Pompili M, Vichi M, Innamorati M, Lester D, Yang B, De Leo D, Girardi P. Suicide in Italy during a time of economic recession: Some recent data related to age and gender based on a nationwide register study. Health Soc Care Community. 2014;22(4):361-7.